Provider Demographics
NPI:1932861119
Name:WALLACE, HOLLI PARKER
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:PARKER
Last Name:WALLACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 TONEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3649
Mailing Address - Country:US
Mailing Address - Phone:704-240-6068
Mailing Address - Fax:
Practice Address - Street 1:1205 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5762
Practice Address - Country:US
Practice Address - Phone:336-684-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional